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The Blast in the Ears: Good Hearing Among War's Casualties

Monday, June 9th 2008

Most of us wear helmets to protect our heads from injury while biking or playing football. In the historical context, however, helmets were thought of as military, not sports gear, intended to protect the warriors heads, faces and necks from injuries inflicted by spears and arrows.

Safeguarding the troops in battle zones remains a top priority. And the need is even more urgent than ever before because, unlike the spears and arrows of antiquity, bombs and bullets of the modern warfare are damaging to the soldiers hearing.

The research continues to focus on designing a more effective helmet to protect the soldiers brains and ears from the harmful effects of loud blasts, and detect early signs of neurological and cognitive damage.

The Sounds of War

No matter which side of the political spectrum you sit on, the undeniable fact is that war is very bad for the soldiers hearing. Research carried out by the U.S Army Center for Health Promotion and Preventive Medicine shows that troops in combat zones are over 50 times more likely to suffer noise-induced hearing loss (NIHL) than soldiers who dont deploy.

Do you think your vacuum cleaner is loud? Consider this: a typical vacuum cleaner emits, according to the Noise Pollution Clearinghouse, an anti-noise organization, between 84 and 85 decibels. An M-16 rifle, on the other hand, registers at 157 decibels, and other weapons can be even louder. The explosion of roadside bombs, for example, is so powerful, it can rupture the eardrum and break bones inside the ear.

Sadly, the full extent of the hearing damage to the troops may not be known for years. What is evident right now from the figures released by the Department of Veterans Affairs (DVA), is that of the 1.3 million U.S. soldiers who served in Iraq since the war started in 2003, nearly 70,000 are currently collecting disability for tinnitus, and more than 58,000 are on disability for hearing loss, making hearing damage the number one disability produced by this war.

But that is not all. The number of troops on hearing damage disability classified as at least 10 percent hearing loss s expected to grow 18 percent a year, with payments totaling $1.1 billion annually by 2011.

The danger of hearing loss in combat zones is not a new discovery. NHIL has been known to be a leading disability among servicemen in World War II and Vietnam. In those battles, hearing was harmed by the artillery noise, bombing raids and tank battles.

Yet, few lessons have been drawn from history: Early on in the Iraq war, the troops had been sent into combat without adequate hearing protection. A report published in 2006 in The ASHA Leader, a newspaper of the American Speech-Language-Hearing Association, states that there was an inadequate supply of earplugs for all soldiers, and a failure to provide unit commanders with information about troops having adequate hearing protection.

No Peace and Quiet

Since in war and peace alike an ounce of prevention is worth a pound of cure, some pro-active steps are being taken by the military command to protect the soldiers hearing.

One example is the Combat Arms Earplug, which blocks harmful noise while allowing the troops to hear normally including noises that might alert them to danger.

Some troops have also received a state-of-the-art headset system, known as QuietPro. It contains digital processors that block out damaging sound waves from gunshots and explosions and still allow users to hear everyday noises.

And there is a potentially promising development from the Navy, which is working with San Diego-based American BioHealth Group to develop a "hearing pill" that could not only protect the soldiers ears, but also possibly reverse other acoustic problems, such as tinnitus and balance disorders. An early study in 2003 on 566 recruits showed a 25 to 27 percent reduction in permanent hearing loss, but further clinical tests are underway.

Shell-Shocked

Soldiers in Iraq are currently using a head and hearing protection called the Advanced Combat Helmet (ACH), which is padded on the inside to prevent sound from reverberating.

However, some critics say the design of current ACHs is flawed. It sits away from the ear so that soldiers can hear and react in a timely manner- to potentially dangerous sounds, leaving ears and necks exposed to injuries.

In combat situations, hearing loss may also result from a blast-related traumatic brain injury (TBI), an unfortunately common affliction in a war zone. The DVA says about 1,800 U.S. troops are now suffering from TBI, and doctors believe that at least 30 percent of the soldiers currently serving in active combat for four months or longer are at risk of head injuries.

However, the true numbers might be even higher than previously believed. The Rand Corporation just released a groundbreaking study estimating that a staggering 320,000 service members may have experienced TBI as a result of recent combat operations.

TBIs can lead to a slew of sometimes-incurable medical conditions, including hearing impairments. For example, a blow to the head could dislocate the three bones of the middle ear, blocking sound from reaching the inner ear. It can also cause a ruptured eardrum or damage the nerves in the cochlea.

Promising Developments Ahead

At this time no foolproof head, neck and ear protection exists, but promising studies are underway. University of Illinois researchers are combining latest technology with their knowledge of biomedical engineering and health sciences, to develop what may prove to be a real lifesaver a smart combat helmet that will be capable of monitoring soldiers brain activity in the battlefield.

Baseline data will be gathered as troops engage in non-threatening activities. Once a big surge in brain activity is spotted, however, all of the recordings will begin in real time so that brain responses can be analyzed. Experts can then assess what is happening to the person much quicker than is possible currently.

At present, TBIs may not be spotted immediately, since symptoms such as cognitive impairment or hearing loss may take time to fully manifest themselves. The earlier the diagnosis is made, the faster appropriate the treatment can be implemented.

The hope is that the smart helmet may just be smart enough to prevent the invisible wounds of war.